How much extra would you pay for local food? It's a familiar question. We face it practically every time we shop for groceries, either at the store or at the farmers market. But what about food that can save the lives of severely malnourished children?

Some humanitarian groups are confronting that question. The food, in this case, is a kind of enriched peanut butter that helps malnourished children regain their health.

The organizations are trying to make this food right where it's used — in Haiti, Malawi, Ethiopia and Niger. They see local production as a way to provide jobs and bring money into impoverished communities. But paying the bill is still a struggle. Even in poor countries, local food often turns out to be more expensive food.

To understand why, we'll take a closer look at one of these places: Cap-Haitien, a city on the northern coast of Haiti.

There's a shantytown on the edge of the city called Shada. The homes are jammed up against each other with barely space to walk between them. And in the middle of this slum, Madame Bwa is running a free clinic.

"This is the list of the kids that we provided services to yesterday," she says, pulling out a ragged piece of paper with 41 names scrawled on it. All of these children, she says, showed signs of malnutrition. "Some of them have big belly or yellow-red hair. Their eyes are white and their skin does not look well."

The prescription? Medika Mamba, Creole for "peanut butter medicine." This peanut butter has a lot of extra ingredients: milk powder, oil, sugar and all the vitamins and minerals a growing child needs.

After three or four weeks of eating this daily package of energy and nutrients, the children will be fine, she says.

Easier, Tastier Treatment

This recipe has transformed the treatment of malnutrition. A French doctor, Andre Briend, came up with it just over a decade ago. In much of the world, it's called Plumpy'Nut. Among specialists, it's called ready-to-use therapeutic food, or just RUTF.

Previously, treatment of severe malnutrition meant liquid milk, sugar, oil and sometimes some added vitamins and minerals. It required refrigeration, in many cases a feeding tube and lots of time in a hospital. Yet many kids still didn't get better.

By contrast, the peanut paste can be eaten at home, children like it, and more survive on it. It's now the gold standard treatment all over the world.

It's a medical triumph. But there's also a business side of this story that's still being written. This is where we run into the tension between the global and local food production.

Why Local Peanuts Cost More

Pat Wolff, a pediatrician from St. Louis, has been living that tension.

In 2003, she founded an organization, Meds and Food for Kids, specifically to bring ready-to-use therapeutic food to Haiti. It started small, grinding up peanuts in a rented house in Cap-Haitien and stirring all of the ingredients together. The group called its product Medika Mamba and distributed it to local clinics.

Yet Wolff wasn't satisfied.

"Why do you suppose those kids are malnourished? It's because their parents have no money, and they have no money because they have no employment," she says.

One day, Wolff had an epiphany. MFK's product might actually provide those much-needed jobs, if it was made on a much bigger scale.

By this time, about five years ago, peanut paste had become big business. UNICEF was buying millions of dollars worth of it every year for distribution in Haiti alone. But UNICEF was buying it from pristine, quality-controlled factories far away — mostly in France. (The leading manufacturer is Nutriset, based in Normandy.) The peanuts came from Argentina, among other places.

Wolff decided MFK could become UNICEF's supplier, with a factory right in Haiti, employing Haitian workers and buying peanuts from Haitian farmers.

It could be an example that others could follow, she thought, "so there would be more factories like this, more factories making other things. There would be more people employed, instead of just always rescuing."

Part of this dream is becoming reality.

The factory, just a few miles from the slums of Cap-Haitien, is filled with stainless steel machines spitting out little sealed packages of enriched peanut butter. Those packages will go to UNICEF, or the World Food Program, and then to hospitals and clinics all over Haiti.

An even bigger impact of this local production might be felt in the countryside, among Haitian farmers who grow peanuts.

Jamie Rhoads, who's been living in Haiti since 2003 and working with MFK since 2009, is in charge of the organization's work with farmers.

As we drive out to meet some of them, Rhoads talks about the potential of this area, the northern plain of Haiti. In colonial times, he says, it was among the richest agricultural areas in the world. "The soil fertility is really good; there's water everywhere; it's, like, this gold mine of agricultural wealth waiting to happen. I mean, look around you — it's totally green. They can grow whatever they want here."

When we get to the farm, we walk right into the middle of a peanut-harvesting party. I see big piles of peanut plants, just pulled from the earth. Men and women are sitting beside them, picking peanuts off the roots and dropping them into buckets. The women are singing; young men are playing wooden flutes.

These farmers are growing peanuts for MFK's new peanut butter factory, and MFK is helping them do it more cheaply. The organization brought in a small tractor to help clear the fields and also sprayed the plants with a chemical that controls fungal diseases.

As a result, the farmers tell me, they're getting almost twice as many peanuts as in previous years.

"This is a big step," says Rhoads, watching the scene. "This is the first time I've been around a harvest where the peanuts look this good. Everybody is telling me, 'In my whole life I've never seen peanuts like this.' "

It's crucial to produce high-quality peanuts, because one of the biggest problems with local production of RUTF in Haiti is the prevalence of peanuts contaminated with aflatoxins. These powerful toxins are "the bane of our existence," says Rhoads. To make sure their product doesn't contain this poison, MFK has to sort its peanuts carefully and test every batch.

More farmers want to join the program, which should mean more peanuts for MFK's factory and more money in farmers' pockets.

It's all great, except for one thing: economics.

These local peanuts still cost too much, in large part because small Haitian farmers have so little machinery. They have to pay people to plant by hand, weed by hand and harvest the peanuts by hand.

So Meds and Food for Kids actually pays more for these Haitian peanuts than peanuts it imports from Argentina, and that higher cost is tough to pass along to customers, Rhoads says. "UNICEF and others are very price sensitive, and we're competing with the international market."

Other organizations that try to make this food locally in other countries report the same thing. Local production often turns out to be more expensive production.

For now, at least, UNICEF has agreed to buy local, even if it costs a little more — even 20 percent more.

But the big, long-term goal, Jamie Rhoads says, is to keep working with the peanut farmers, helping them grow more peanuts for less money.

Rhoads thinks they can do it, with some new disease-resistant peanut varieties currently grown in India and now being tested in Haiti, and a little more labor-saving equipment. If they succeed, he says, these farmers won't even need MFK's factory anymore. They'll be able to sell their peanuts for a good price at any market in Haiti.

They'll make a lot of money, he says, and in the end, that's the best way to make sure their children won't go hungry.

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

We turn now to the decision we face every time we shop for groceries: The choice between food from local farmers and cheaper, mass produced alternatives, except, in this story, lives are at stake. The food we're talking about is a kind of fortified peanut butter that's saving the lives of malnourished children in dozens of countries around the world. And aid organizations are now thinking: If they could make this food locally, they could have an even bigger impact. They could create jobs, for instance, in Haiti where 80 percent of people don't have work.

NPR's Dan Charles has that story.

DAN CHARLES, BYLINE: On the northern coast of Haiti, in the city of Cap-Haitien, there's a shantytown called Shada where people live on almost nothing. The homes are jammed up against each other with barely space to walk between them. And in the middle of this slum, a powerhouse of a woman named Madame Bwa runs a free clinic. If your child is sick or weak, you go to Madame Bwa.

MADAME BWA: (Through Translator) This is the list of the kids that we provide services yesterday.

CHARLES: She pulls out a ragged piece of paper with 41 names scrawled on it. All of these children, she says, came in suffering from malnutrition.

BWA: (Through Translator) Some of them have big belly. They have yellow-red hair.

After three or four weeks, eating this daily package of energy and nutrients, the children will be fine.

BWA: (Foreign language spoken)

CHARLES: So 10 years ago, if these children showed up, what did you give them then?

UNIDENTIFIED MAN #1: (Foreign language spoken)

BWA: (Through Translator) Oh, they used to die. They used to die. They used to die.

CHARLES: Just over a decade ago, a French doctor came up with this peanut butter recipe and called it Plumpy'Nut. It was first tested in the African country of Malawi. Pediatrician Pat Wolff learned how to make it there. She is the person who first brought it to Haiti and called her version Medika Mamba.

PAT WOLFF: The previous 70 years, the recommendation from the World Health Organization had been liquid milk with a little sugar and oil in it, and sometimes extra vitamins and minerals if you could ever find them.

CHARLES: But that earlier treatment required refrigeration for the milk. Often, it took a feeding tube.

WOLFF: And it required the parents to be in the hospital with the child for a month.

CHARLES: This new peanut paste has turned out to be better in almost every way. Children like it. They can eat it at home, so it's easier on families. And more sick children survive by far.

All over the world, this so-called ready-to-use therapeutic food has become the gold standard for treating severely malnourished children. So that's the medical side of the story, an amazing success. But there's also a business story that's still being written.

WOLFF: Okay. Hi, guys. So...

CHARLES: I met Pat Wolff in a brand-new building a few miles outside Cap-Haitien. These are the new offices of the organization she founded: Meds and Food for Kids.

WOLFF: We're not really completely moved in yet.

CHARLES: Wolff set up Meds and Food for Kids in 2003 to bring ready-to-use therapeutic food to Haiti. They started in a small rented house grinding up peanuts in the kitchen, stirring all the ingredients together by hand, distributing their Medika Mamba to local clinics. But she felt like just passing out food wasn't enough.

WOLFF: We came here to rescue kids, right? But, you know, that doesn't go anywhere. It goes nowhere except to more rescue. Why do you suppose those children are malnourished? They're malnourished 'cause their parents have no money, and they have no money because they have no employment.

CHARLES: One day Pat Wolff had what she calls an epiphany. Medika Mamba, she realized, could provide employment if she made it on a much bigger scale because by this time - it was about five years ago - ready-to-use therapeutic food had become big business. UNICEF was buying millions of dollars worth of it every year for distribution in Haiti alone. But UNICEF was buying it from pristine, quality-controlled factories far away, mostly in France. The peanuts came from places like Argentina.

Pat Wolff thought we can make it here, in a factory employing Haitian workers buying peanuts from Haitian farmers. She thought it could be an example that others could follow.

WOLFF: So that there would be more factories like this, more factories making other things, more people being employed instead of just always rescuing.

CHARLES: That's the dream and part of it is becoming reality.

Pat Wolff's group, Meds and Food for Kids, has a big new factory just a few miles from the slums of Cap-Haitien. MFK's Jamie Rhoads takes me on a tour.

JAMIE RHOADS: That noise you're hearing is the sound of money.

(LAUGHTER)

RHOADS: No, it's the - every time you hear that noise, it's 92 grams of hot peanut butter getting pushed into a little bag.

(SOUNDBITE OF MACHINERY)

CHARLES: Those little sealed packets will go to UNICEF or the World Food Program and then to hospitals and clinics all over Haiti. But potentially, an even bigger impact will be felt in the countryside, among Haitian farmers who grow the peanuts.

Jamie Rhoads is the person at MKF who works most closely with the farmers. He takes me out to meet some of them. The road there is terrible, unpaved and rocky. But Rhoads says look at this land. There's not much growing there now. But this northern plain of Haiti used to be one of the wealthiest agricultural areas in the world. And it could be again.

RHOADS: The soil fertility is really good. There's water everywhere. And it's just kind of like this gold mine of agricultural wealth waiting to happen, I think. I mean, look around you. It's totally green. Whatever they need, they can grow in this northern plain.

UNIDENTIFIED GROUP: (Singing in foreign language)

CHARLES: We get to the farm and walk right into the middle of a party, a peanut harvesting party. It's a small taste of that agricultural wealth that Jamie Rhoads is dreaming about. These farmers are growing peanuts for MFK's new peanut butter factory, and MFK is helping them do it more cheaply. The organization brought in a small tractor to help clear the fields and also sprayed the plants with a chemical that helps control fungal diseases.

UNIDENTIFIED MAN #2: (Foreign language spoken)

CHARLES: The farmers tell me, as a result, they're getting almost twice as many peanuts as in previous years. I see big piles of peanut plants just pulled from the earth. Men and women are sitting beside them, picking peanuts off the roots and dropping them into buckets.

RHOADS: This is a big step. I mean, this is the first time I've been around in a harvest where the peanuts look this good. And I think the excitement that you're hearing in the background is the people responding to that as well because everyone is telling me, in my whole life, I've never seen peanuts like this.

CHARLES: More farmers want to join the program, which should mean more peanuts for MFK's factory and more money in farmers' pockets.

It's all great, except for one thing: economics. These local peanuts still cost too much. It's mainly because small Haitian farmers have so little machinery. They have to pay people to plant by hand, weed by hand, harvest the peanuts by hand. Meds and Food for Kids actually pays more for these Haitian peanuts than peanuts that they import from the U.S. or Argentina. And that higher cost is tough to pass along to customers.

RHOADS: We sell to UNICEF, and UNICEF and others are very price sensitive. And we're competing with the international market.

CHARLES: Other organizations that try to make this food locally in other developing countries report the same thing. Local small-scale production turns out to be more expensive production. For now, at least, UNICEF has agreed to buy local even if it costs a little more, even 20 percent more.

But the big, long-term goal, Jamie Rhoads says, is to keep working with the peanut farmers, helping them grow more peanuts for less money. Rhoads thinks they can do it with some better peanut varieties that resist disease and a little more labor-saving equipment. And then, he says, those farmers won't even need MFK's factory anymore. They'll be able to sell their peanuts for a good price at any market in Haiti.

They'll make a lot of money. And in the end, he says that's the best way to make sure that their children won't go hungry.

Dan Charles, NPR News.

(SOUNDBITE OF MUSIC)

CORNISH: Tomorrow, on MORNING EDITION, Dan Charles looks into whether there can be too much life-saving peanut paste. Two humanitarian groups have built factories in Haiti to make it, but the country probably only needs one. Transcript provided by NPR, Copyright National Public Radio.